Edith's story

Edith was 90 years old with a large squamous cell cancer growing through her lower jaw and the skin of her lip and chin. After long discussions, she opted to have surgery to remove this. After all, as Edith pointed out, she still had plenty of years left ahead of her!

She underwent resection of the front of her lower jaw and chin and the lymph glands in her neck (radical neck dissection). After this her reconstruction was simplified to ensure a shorter operation. Her remaining jaw was held in position with a strong titanium metal plate bent to the correct shape and the skin of her chin was reconstructed with muscle and skin from her chest wall (pectoralis major myocutaneous pedicled flap based on the pectoral artery and vein from the acromiothoracic vessels). The operation took a total of 6 hours and Edith made a miraculous recovery. She lived for a further 2 years without the cancer returning and was able to eat and speak relatively well before dying peacefully at home. This painting shows her immediately at completion of the operation.

David's story

In 1990 at the age of 23, David had a dramatically small lower jaw. This meant that his lower lip was permanently curled over his chin and he had sores on his chin crease almost all the time because of saliva collecting in this area. His gums were also stretching away from his lower incisor teeth because of the pull of his lower lip. The lower teeth were positioned far behind the upper set and because of this he could only eat soft foods.

In the same year he underwent surgery in which his lower jaw was fractured on both sides at the back and bone grafts using his own ribs were inserted to push it forward (inverted L osteotomies). His jaws were fixed in place with metal plates.

Following this surgery his life has improved dramatically. He is able to eat a normal diet and no longer has any sores on his chin. Prior to the operation people stared at him because of his absent chin and he lacked confidence, but he is now no longer self-conscious about his appearance.

He is now married, works as a service engineer and enjoys playing football as a centre-forward. He supports West Ham United.

Julian's story

Julian was 21 years old in 2000 when his car crashed into a lamp-post, following which he was ejected through the sunroof and landed face first against the same lamp-post.

He sustained severe injuries to his skull and facial bones so that he was on the intensive care unit for several days before he was fit to undergo a major operation. His frontal bones, right and left eye sockets, nasal bones, upper jaw and lower jaw were all fractured. The resulting effect was of protrusion of his right eye and a lowering of the level of his left eye.

He underwent two operations. The first was conducted shortly after his admission when a breathing tube (tracheostomy) was inserted into the lower part of his neck, his lower jaw and skull fractures were repaired and his brain swelling was decompressed. A few days later, through an incision over the top of the head (bicoronal flap), the scalp was "peeled down" to expose the bones of the face, his eye sockets were reconstructed and replaced in their correct position as were his nose, eyelids and upper jaw. All of these were held together with metal titanium plates. The scalp was replaced at the end of the operation and sutured in place.

Julian enjoys go-karting, playing football as a forward and he supports Arsenal. He lives with his mother and brother Leon. He sells mobile phones and does electrical work.

At the time of painting, Henry was a 34-year-old forensic mental health nurse working in a behaviour modification unit in London. He lived with his wife Gloria and two-year-old son Jeremiah.

His story starts in Nigeria in 1991 where he underwent several operations culminating in the removal of all his right upper jaw and maxillary sinus for what was thought to be a benign tumour. In fact it was a malignant bone tumour (osteosarcoma). He sought treatment from lain Hutchison in the UK but was advised that because of the position of the tumour an unacceptable amount of his face would need to be excised to achieve its total removal.

With the help of friends, family and his employer, Henry raised enough funds to pay for his travel, hospital and accommodation bills.

When he arrived in the UK in 1991 the tumour was growing at four separate sites: the roof of his nose and bulging out through the right side of his nose; behind his right eye pushing this forward; in his right cheekbone and in his right temple, destroying the skull and facial bones at these sites.

He was immediately treated with chemotherapy for six months. He then underwent a twenty-hour operation in which his nose, right face including skin and underlying bone, right eye, right temple, and the bones separating his brain from his eye socket and nose were removed. This area was built up using rib to reconstruct the underlying facial architecture, latissimus dorsi muscle from the back to seal the space between the brain and the mouth, and skin from the back to replace lost skin. After this he received a six-week radiotherapy course. The tumour recurred five years later, in 1996, on the left side of his upper jaw. On this occasion Henry's left upper jaw, sinus and nasal support were removed. No surgical reconstruction was carried out, but he was fitted with a large denture (obturator) to fill the space.